TRAINING REFLECTION FEEDBACK FORM – MEPA National Resource Center for Adoption “A Service of the Children’s Bureau & Member of the T/TA Network” We need your feedback. Please select the response that best reflects your view. Your responses are completely confidential. T/TA Topic Site Trainer(s) Internal # Location (City, State) Date(s) TATIS # 1. Please rate: Excellent Good Fair Poor Excellent Good Fair Poor Excellent Good Fair Poor Excellent Good Fair Poor The interrelatedness of the concepts, methods and tools presented. Immediate usefulness of the information to your job responsibilities and/or role. Relationship of the information presented to the stated objectives. Technical assistance overall 2. Please rate Consultant #1 (enter name): Knowledge of the technical assistance content/topic Respect for the experiences and knowledge of participants Ability to relate to the group Training skills Overall effectiveness 3. Please rate Consultant #2 (enter name): Knowledge of the training content/topic Respect for the experiences and knowledge of participants Ability to relate to the group Training skills Overall effectiveness 4. Please rate: Quality and relevance of materials used. 5. As a result of this training activity, I Strongly Agree Agree Neither Agree or Disagree Disagree Strongly Disagree Have gained new or enhanced knowledge of evidence Have gained new or enhanced skills Am more knowledgeable of evidence-based practices and how to use them to overcome barriers to permanency Can implement the skills, methods and techniques presented. 6. Regarding this training activity: Definitely Somewhat No N/A I am receptive to learning about new strategies I am receptive to the implementation of new strategies provided My organization has resources (personnel and budgetary) to implement the strategies provided Individuals at the administrative and policy-maker level support implementation of the strategies provided We have completed or have the capacity to develop viable plans for implementation of the strategies Management was involved in this training activity 7. Comments _____________________________________________________________________________________ _________________________________________________________________________________________________ 8. Please list two things you found most helpful or useful. _______________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Developed by Public Research and Evaluation Services for the National Resource Center for Adoption, A Service of the Children’s Bureau, 8/26//09. 9. Please list two things that would improve this or future sessions. ______________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 10. How did you hear about the training activity?  Agency sponsored  NRC mailing  Spaulding web site  National Resource Center for Adoption web site  Conference materials  Other (please specify): ______________________________________________________________________ 11. What is your current primary role? (Check one):  Child Welfare  Direct Service Provider  Supervisor  Administrator  Trainer  Other (please specify): _____________________________________________ (For those who chose Child Welfare above, please indicate your other area of responsibility in #12a and 12b below.) 12. Please pick your area of responsibility (Check one):  Intake  Child Abuse/Neglect Investigation  Foster Care  Licensing  Adoption  Post Placement  Other (please specify): ______________________________________________________________________ 13. Other roles (Check one):  Teacher  Judge  Attorney  Legal Staff Mental Health Provider  Parent: (  Birth  Foster  Adoptive  Kinship) 14. Total years of experience in your current role _________ 15. Years of experience in child welfare ________ 16. What is your age range: 17. Gender:  Male 18. Ethnicity:  Hispanic  21-30  31-40  41-50  51-60  61+  Female  Non-Hispanic 19. Race:  American Indian/Alaskan Native  African American  Asian  Black  Native Hawaiian  Pacific Islander  White  Some Other Race (specify): ______________ ______  Two or more races (specify): ___________________  Other (specify):______________________________ 20. Highest Education Level Completed: Less than High School  High School  Two-year Community College  Four-year College/University  Graduate School  Vocational/Technical College  Apprenticeship Program  A Trade School 21. Is your system:  State administered  County administered 21. Organization Affiliation:  Public Child Welfare Agency  Private Child Welfare Agency  Other Public Agency  Other Private Agency  School  Other (please specify) _____________________________________ 22. Organization Geographic Location (state):____________________________________________ If you are interested in participating in follow-up evaluation activities for the National Child Welfare Resource Center for Adoption, please provide your: (Please print) Name ____________________________________________________________________________ Address ________________________________________________________________________________________ Phone Number ________________________________ E-mail _________________________________ Thank you. Developed by Public Research and Evaluation Services for the National Resource Center for Adoption, A Service of the Children’s Bureau, 8/26//09.